Olivia Mitchell
Ceist:72 Ms O. Mitchell asked the Minister for Health and Children if he will report on the current status of and future plans for the pilot cervical screening programme in Limerick. [27647/03]
Ceisteanna – Questions (Resumed). Priority Questions. - Cancer Screening Programme.
Phase one of the national cervical screening programme has been up and running in the Mid-Western Health Board since October 2000. Under the programme cervical screening is being offered to approximately 74,000 women, aged 25 to 60, free of charge at five-year intervals. A commitment was given in the national health strategy to extend the programme to the rest of the country. A key objective is to ensure that the programme is driven by international quality assurance criteria and best practice.
The process of implementing and organising the national programme is a major undertaking that requires careful consideration involving significant logistical and resource implications. The health boards executive, HeBE, is examining the feasibility and implications of a roll-out of the national programme. A key element of this work is a review of phase one. Other aspects of the examination include policy development, establishment of national governance arrangements, learning derived from other national programmes and current international best practice.
The evaluation of phase one, which comprises an integrated evaluation and planning approach, is currently under way. The retrospective analysis is being linked closely to established best practice and emerging international thinking on cervical screening, and it is intended that this will inform the development of a high quality cervical screening model for Ireland. The evaluation dimensions of the review include the overall approach to be taken by the national programme in the context of best practice elsewhere, quality assurance arrangements, standard operating procedures, governance arrangements, business model and organisational arrangements, programme screening policies, a population register, risk analysis and payment arrangements. It is expected that this evaluation of phase one will be completed early in 2004. A separate study relating to the functioning of the programme in terms of its women's charter is under way and will also be completed in 2004.
In regard to policy development for the national programme, I am advised that the sub-group established by HeBE and led by Dr. Sheelah Ryan, chief executive officer of the Western Health Board, is currently preparing a series of policy proposals to be adopted by the programme. These policy proposals will address a wide range of issues including the priority target groups to be reached by the programme, the most appropriate screening intervals, laboratory accreditation, the use of liquid-based cytology, information systems, HPV immunisation and the development of population registers. In summary, the evaluation of phase one is a major part of the planning process for the national programme and once it is completed, HeBE has advised that it will be in a position to prepare a draft roll-out plan. Governance structures for the full national programme are also being considered. A final decision on structures will be taken in the context of the evaluation report and roll-out plan.
Will the Minister agree that the pilot project, such as it is, has been an unmitigated disaster? It has been running for almost six years. To talk about best practice and quality assurance in the context of what is called a pilot programme is a joke. The take-up rate is almost negligible. There is no follow-up system, no database and no recall system. There has been no roll-out. It is impossible to evaluate because there is nothing to evaluate, yet it is costing millions of euro. In 2001 there were 16 people working on the project and now there are 27. Nobody seems to know what has been achieved. The technology is outdated. Less is being achieved in terms of screening than in areas where there is no pilot programme. Lives are being lost while we proceed with this farce. Why do we stick with it? It has been a disaster by any standard. Is it not time to abandon it rather than review it and roll out a proper programme nationally into which some thought has been put? This is not a pilot programme in any real sense – it is not even a programme.
If my memory serves me correctly, it was the Deputy's colleague, Deputy Noonan, who decided to initiate the pilot project during his time as Minister for Health.
Yes.
That is true.
It has been running for six years and no progress has been made.
I take the Deputy's point, but that is the reason we need to get it right if we are to roll it out nationally. The review is being conducted by a UK consultant cytopathologist, Dr. Euphemia McGoogan, who is a renowned international expert in the area of cervical screening. Before we consider rolling out the project further it is important that we carry out a proper review. It will be a similar process to that which pertained for the BreastCheck programme, which was nearly two years in preparation before we started phase one.
A total of 74,000 women are being screened annually. The Deputy was correct about the uptake, which is about 30%.
It is less.
These are the figures I have received. There is an issue with ongoing routine screening around the country. We have put extra money into routine screening to bring waiting times down. Contracting out testing, especially to laboratories in Northern Ireland, has resulted in a significant reduction in waiting times in a range of laboratories. This represents some progress. Waiting times are being reduced in Cork Univer sity Hospital, where it is a huge problem, and Sligo General Hospital. We have problems with this across the country but waiting times are being reduced in many places.
In terms of the national roll-out and the wider cervical screening programme, it is necessary to get it right. We must use whatever resources we have to target those most in need, especially those who do not self-refer. That is exactly what is taking place.
While I agree with the Minister that we have to get it right, we are not going to do so by trying to evaluate something that is an obvious failure. The Minister referred to a backlog. Last July, Limerick hospital was promised money to use the more up to date liquid-based cytology but has not received the money. It is probably the only area in the country that has not progressed.
Some months ago the Minister told me that smears from Cork were being sent to Belfast. Belfast is progressing to more modern technology and will not be able to read those smears. We must make decisions in this area. This is an area of screening where the jury is not out. It works and saves lives. While I can see the Minister throwing his eyes up to heaven, this is an area where screening works.
I take the Deputy's point. The review is a major part of the roll-out of the national programme.
They have not had a programme there.
Each component part must be gone through before it is rolled out nationally. This is the correct thing to do.